Venous History

1) Have you experienced any of the following symptoms within the past year?

Not applicable

Syncope

Vertigo

Shortness of breath

Nausea / vomiting

Skin pigment changes

Sinus trouble

Seizure

Visual skin changes

Wheezing

Blood in urine

Skin rash / itching

Abdominal pain

Tremors

Hearing loss

Chest pain

Blood in stool

Bruising easily

Constipation

Chances in memory

Ringing in ears

Palpitations

Diarrhea

Joint pain

Muscle pain

2) How long have your legs bothered you?

3) Does one leg bother you more than the other?

4) How much leg pain/discomfort have you had in the past 4 weeks?

5) At what time of day are leg symptoms the worse?

6) Are leg symptoms made worse by heat?

7) Have you ever worn compression stockings?

If YES, please select one option:

under 3 months

3-6 months

6-12 months

over 1 year

7a) Have you done leg exercises and leg elevation?

8) Have you had lower extremity vein / vascular treatment in the past?

If YES, please explain:

9) Have you experienced any of the following symptoms within past 4 weeks? (Check all that apply):

Heavy legs / fullness

Restless legs

Swelling

Itching skin

Aching

Pain

Fatigue

Burning / numbness

Pelvic symptoms

Cramping

Ruptured varicosities

Ulcers / wounds

Bruising easily

Rash or eczema (ankle only)

Purple discolouration in skin of legs

10) During the past 4 weeks, how much trouble have you had carrying out the actions and activities listed below because of your leg problems?

no trouble

slight trouble

moderate trouble

considerable trouble

could not do it

Remaining standing for a long time

Remaining standing for a long time no trouble

Remaining standing for a long time slight trouble

Remaining standing for a long time moderate trouble

Remaining standing for a long time considerable trouble

Remaining standing for a long time could not do it

Doing certain jobs at home (e.g. standing and moving around in the kitchen, cleaning the floor, or other house projects...)

Doing certain jobs at home (e.g. standing and moving around in the kitchen, cleaning the floor, or other house projects...) no trouble

Doing certain jobs at home (e.g. standing and moving around in the kitchen, cleaning the floor, or other house projects...) slight trouble

Doing certain jobs at home (e.g. standing and moving around in the kitchen, cleaning the floor, or other house projects...) moderate trouble

Doing certain jobs at home (e.g. standing and moving around in the kitchen, cleaning the floor, or other house projects...) considerable trouble

Doing certain jobs at home (e.g. standing and moving around in the kitchen, cleaning the floor, or other house projects...) could not do it

Sitting for long periods of time.

Sitting for long periods of time. no trouble

Sitting for long periods of time. slight trouble

Sitting for long periods of time. moderate trouble

Sitting for long periods of time. considerable trouble

Sitting for long periods of time. could not do it

Going out for the evening, to a wedding, a party, a cocktail party...

Going out for the evening, to a wedding, a party, a cocktail party... no trouble

Going out for the evening, to a wedding, a party, a cocktail party... slight trouble

Going out for the evening, to a wedding, a party, a cocktail party... moderate trouble

Going out for the evening, to a wedding, a party, a cocktail party... considerable trouble

Going out for the evening, to a wedding, a party, a cocktail party... could not do it

11) Leg problems can also affect your spirits. How closely do the following statements correspond to how you have felt during the past 4 weeks?

not at all

a little

moderately

a lot

completely

I felt nervous / tense

I felt nervous / tense not at all

I felt nervous / tense a little

I felt nervous / tense moderately

I felt nervous / tense a lot

I felt nervous / tense completely

I got tired quickly

I got tired quickly not at all

I got tired quickly a little

I got tired quickly moderately

I got tired quickly a lot

I got tired quickly completely

I felt I was a burden

I felt I was a burden not at all

I felt I was a burden a little

I felt I was a burden moderately

I felt I was a burden a lot

I felt I was a burden completely

I felt embarrassed about my legs

I felt embarrassed about my legs not at all

I felt embarrassed about my legs a little

I felt embarrassed about my legs moderately

I felt embarrassed about my legs a lot

I felt embarrassed about my legs completely

I got irritated easily

I got irritated easily not at all

I got irritated easily a little

I got irritated easily moderately

I got irritated easily a lot

I got irritated easily completely

I always had to be cautious

I always had to be cautious not at all

I always had to be cautious a little

I always had to be cautious moderately

I always had to be cautious a lot

I always had to be cautious completely

I felt as if I was handicapped

I felt as if I was handicapped not at all

I felt as if I was handicapped a little

I felt as if I was handicapped moderately

I felt as if I was handicapped a lot

I felt as if I was handicapped completely

I found it hard to get going in the morning

I found it hard to get going in the morning not at all

I found it hard to get going in the morning a little

I found it hard to get going in the morning moderately

I found it hard to get going in the morning a lot

I found it hard to get going in the morning completely

I did not feel like going out

I did not feel like going out not at all

I did not feel like going out a little

I did not feel like going out moderately

I did not feel like going out a lot

I did not feel like going out completely

12) During past 4 weeks, to what extend did you feel bothered/limited in your work or your other daily activities because of your leg problems?

not bothered or limited

a little bothered / limited

Moderately bothered / limited

very bothered / limited

extremely bothered / limited

not bothered or limited

a little bothered / limited

Moderately bothered / limited

very bothered / limited

extremely bothered / limited

13) During the past 4 weeks, did you sleep badly because of your leg problems, and how often?

seldom

fairly often

very often

every night

13) During the past 4 weeks, did you sleep badly because of your leg problems, and how often? seldom

13) During the past 4 weeks, did you sleep badly because of your leg problems, and how often? fairly often

13) During the past 4 weeks, did you sleep badly because of your leg problems, and how often? very often

13) During the past 4 weeks, did you sleep badly because of your leg problems, and how often? every night

14) In the last 2 weeks for how many days did your veins cause you pain or ache?

Not at all

Between 1 and 5 days

Between 6 and 10 days

For more than 10 days

Right leg pain

Right leg pain Not at all

Right leg pain Between 1 and 5 days

Right leg pain Between 6 and 10 days

Right leg pain For more than 10 days

Left leg pain

Left leg pain Not at all

Left leg pain Between 1 and 5 days

Left leg pain Between 6 and 10 days

Left leg pain For more than 10 days

15) During the past 2 weeks, on how many days did you painkillers or anti-inflammatories for your leg symptoms?

None at all

Between 1 and 5 days

Between 6 and 10 days

For more than 10 days

Right leg pain pills

Right leg pain pills None at all

Right leg pain pills Between 1 and 5 days

Right leg pain pills Between 6 and 10 days

Right leg pain pills For more than 10 days

Left leg pain pills

Left leg pain pills None at all

Left leg pain pills Between 1 and 5 days

Left leg pain pills Between 6 and 10 days

Left leg pain pills For more than 10 days

16) In the last 2 weeks, how much ankle swelling have you had?

None at all

Between 1 and 5 days

Between 6 and 10 days

For more than 10 days

Right leg swelling

Right leg swelling None at all

Right leg swelling Between 1 and 5 days

Right leg swelling Between 6 and 10 days

Right leg swelling For more than 10 days

Left leg swelling

Left leg swelling None at all

Left leg swelling Between 1 and 5 days

Left leg swelling Between 6 and 10 days

Left leg swelling For more than 10 days

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Dr. Rose’s reviews on Healthgrades

See Dr. Rose’s profile on Healthgrades.

Spider Vein Treatment Cost
Starting at $250

What is the cost of sclerotherapy? Very simple, Sclerotherapy costs start at $250 per leg. Touch-up or follow-up is $100.

Sclerotherapy is a very popular procedure used to treat deficient blood vessels. Medicine is injected, using a very small gauge needle, into the veins that act as an irritant of the inner vein walls, causing closure of the treated spider vein. Most patients require multiple sessions, however, the number of treatments is based on your specific condition.

Over time, the appearance of spider veins fade from sight, leaving you with clearer, healthy looking legs. Your spider vein specialist is able to treat more than one vein at the same time.

Together we’ll get you to love your legs!

Pigmented Lesions Laser Treatment

Our state-of-the-art Pulsed Dye Laser and Intense Pulsed Light (IPL) delivers an intense but gentle burst of light into selectively targeted areas of the skin. The light is absorbed by specific blood vessels or melanin pigmented areas in the dermis depending on the condition being treated. Factors such as the age, color and type of lesions, as well as the location on the body, all determine whether lesions can be removed. The Harmony DYE VL we utilize will help fade vascular lesions to look like normal skin.

Port Wine Stains Laser Treatment

Geneticists recently identified the genetic marker that causes port wine stains, or birthmarks. Occurring in about 3 out of every 1,000 births, port wine stains are enlarged capillaries that produce purplish-red stains on the skin. Rarely causing an health issues, port wine stains occasionally grow thicker or bumpy over time. Laser treatments are now a routine procedure for the removal of many types of vascular lesions, including hemangiomas, vascular malformations such as port-wine stains, telangiectasias, venous lakes and angiomas. Multiple treatments are required for optimal results. On average, most patients with port wine stains need at least 12 treatments, some need 18, and we’ve treated many patients with more than 25 treatments. It is rare to completely clear the stain.

What to expect after laser vein treatment

Some redness, slight swelling may be present in the area that has been treated, however this should subside within a few hours. Bruising may also occur.
You will be given instructions on post treatment care, including keeping the treated area clean, using at least an SPF 15 sunscreen when you go outdoors.

Face Veins Laser Treatment

Occasionally, spider veins will appear on the face, called Facial Telangiectasia. These are small, red or purple blood vessels that can be caused by a number of skin conditions, including sun damage, heredity, rosacea, hot and spicy food, exercise or emotions. Our new laser penetrates deep down and is absorbed by the cells in the vessel wall and the blood causing coagulation and seals off the blood flow. The vessel walls then collapse and eventually dissolve.

Vascular Lesion Laser Treatment

Varicose and spider veins are blood vessels that become enlarged and visible due to weakened valves, which cause blood to pool rather than flow to the heart. Our new vascular treatments offer effective, non-invasive solutions that close these veins and reduce or even eliminate their appearance. A variety of technologies are used to target the affected blood vessels beneath the skin, leaving you with smooth, clear skin and renewed confidence. The treatments are safe and effective and provide reliable, long term results.

Laser vein treatment

Laser treatment to eradicate spider veins and small varicose veins with a unique wavelength of light is now possible. This non-invasive laser vein treatment utilizes a long pulse of light laser energy to destroy the defective vein altogether. The wave energy targets the area under the skin’s surface so that the top layer of skin is left completely intact and untouched. The vein absorbs the laser energy and then immediately collapses, with an immediate visible washing out of the vessel.

Advanced fluorescence technology (AFT) and cutting-edge laser technology make it possible to reduce and even eliminate your problematic veins, sometimes in just one sitting. Depending on the severity of your case, Dr. Rose may recommend up to three sessions, but the results are immediate and long-lasting. Fight the signs of aging the easy way and eliminate ugly or painful varicose or spider vein abnormalities with the most effective laser treatment. Our laser vein treatment is safe for all skin types, pain-free, and non-invasive with virtually no side-effects!

Testimonials Disclaimer

Testimonials found on Advanced Vein Institute of Arizona have been sent to us by actual patients and may not reflect the typical patient’s experience and are not intended to represent or guarantee that everyone will achieve the same or similar results. The testimonials are meant to be a showcase of the best results our practice has produced, and should not be taken as the results all patients will get.